Risk factors for cardiovascular disease (CVD) disproportionately affect low income and minority populations. Lenoir County, North Carolina is among the poorest in the state and situated in the stroke belt with significantly elevated heart disease, stroke, and obesity rates relative to state levels already well above the national average. At the same time, this county is home to many clinical and public health efforts on which to build. We propose an integrated set of three interdisciplinary studies in Lenoir County to: 1) determine genetic factors associated with CVD risk; 2) understand the multilevel determinants of poor health outcomes and the potential social and community capital that can support sustainable change; 3) work with community leaders, health professionals, and citizens to apply these understandings to improved practice-based management of hypertension and community-centered lifestyle management, and test the impact on improving outcomes and reducing disparities in cardiovascular health among 700 participants. This will include an innovative partnership with a nonprofit call center, Connect Inc, adding a lifestyle and medication adherence coaching component to their current focus on jobs, employment, and benefits counseling; 4) test the impact, reach, adoption, and sustainability of clinical, community-level, and policy interventions , including economic development potential; and 5) develop and implement strategies for translation and dissemination of the clinic-based and community-level interventions to other underserved regions. This work will be supported by an administrative core housed in the Center for Health Promotion and Disease Prevention (a CDC funded Prevention Research Center with a focus on community-based participatory research). Additional cores include: 1) a Genomic Bioinformatics Core available to this project and other PSO programs to analyze genetic/genomic data and other pathways of interest; and 2) a Social Determinants/Economic Development/Dissemination Core to understand the interface between poverty and health, and explore strategies with the potential to create jobs while promoting health. Additional core support for data collection, community engagement, and economic development will be leveraged through the UNC CTSA (NC TraCS) and the Community-Campus Partnership for Tomorrow, which is the result of a statewide assessment led to the President of the UNC (16 campus) system to to produce a more proactively responsive University focused on meeting the challenges of the state over the next 20 years.